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Case Law Database

Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. ADJ6650899
Regular
Jan 04, 2013

IVAN MORENO vs. SOSA GRANITE & MARBLE, MAJESTIC INSURANCE COMPANY

In this workers' compensation case, the Board granted reconsideration to clarify an existing award. The administrative law judge had previously imposed a $10,000 penalty for unreasonable delay in paying permanent disability benefits, based on 25% of the overdue amount, capped as allowed by law. The defendants contended the penalty was improperly calculated on the total awarded benefits rather than the amount delayed. The Board affirmed the penalty and its amount, clarifying that it was based on the unpaid permanent disability indemnity due at the time of the award, not the total sum. This penalty was justified because the defendants unreasonably delayed paying any permanent disability advances for over three years after the applicant's condition became permanent and stationary.

permanent disabilityLabor Code section 5814penaltyunreasonable delayreconsiderationFindings of Fact and Awardadministrative law judgeSosa Granite & MarbleMajestic Insurance CompanyWCJ
References
0
Case No. ADJ8406355
Regular
Sep 06, 2016

JORGE GARCIA vs. SARA LEE CORPORATION, ACE AMERICAN INSURANCE COMPANY c/o ESIS

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a judge's award finding Sara Lee Corporation liable for a penalty based on the full $8,000 supplemental job displacement voucher, plus penalties for medication delays and attorney fees. The WCAB agreed that the penalty for the delayed voucher should be limited to 25% of the *actual amount used* by the applicant, not the full voucher amount. The WCAB otherwise affirmed the judge's findings on medication delays and attorney fees, adopting the judge's report.

Supplemental Job Displacement VoucherIndependent Medical ReviewLabor Code section 5814PenaltyReconsiderationFindings and AwardWCJAppeals BoardAttorney's feesActual time spent
References
2
Case No. ADJ7191867
Regular
Mar 23, 2012

ARTURO ESCOBAR vs. HENRY WINE GROUP dba ZEPHYR EXPRESS, ZURICH AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior decision because the WCJ's imposition of a 20% penalty for delayed payment did not adequately explain the penalty amount based on established legal factors. While a delay in payment was found, the Board remanded the case for the WCJ to re-evaluate penalties and interest by clearly applying factors from relevant case law and justifying the awarded amounts with specific evidence. The original decision also failed to separately address statutory interest owed on the delayed payment. The Board emphasized the need for decisions to articulate the evidentiary basis and reasoning for penalty assessments.

Labor Code section 5814Petition for ReconsiderationFindings and AwardWCJZurich American Insurance CompanyArturo EscobarHenry Wine GroupZephyr ExpressCompromise & Releasepenalty
References
7
Case No. ADJ6973825
Regular
May 21, 2012

MONICA BENARD vs. JENNY CRAIG, SEDGWICK CMS

This case concerns a penalty imposed on Jenny Craig for unreasonably delaying authorization for applicant Monica Benard's chiropractic treatment. The WCJ found a 25% penalty for the delay, which Jenny Craig appealed, arguing the delay was due to the applicant's choice of a chiropractor outside their Medical Provider Network (MPN). The Appeals Board affirmed the unreasonable delay finding but reduced the penalty to 20% of the delayed treatment's value, citing a failure in case management rather than intentional disregard. Jurisdiction was reserved for the parties to adjust the penalty amount.

Workers Compensation Appeals BoardMonica BenardJenny CraigSedgwick CMSADJ6973825ReconsiderationFindings and AwardLabor Code section 5814Medical Provider Network (MPN)chiropractic treatment
References
9
Case No. ADJ4702650 (MON 0094741), ADJ1144686 (MON 0124794)
Regular
2012-2011

ANA SAMI vs. HUGHES AIRCRAFT COMPANY, SPECIALTY RISK SERVICES, INC.

The Appeals Board partially granted reconsideration, reversing most penalties for unreasonable delay and sanctions against the applicant's attorney, finding insufficient evidence for these claims. However, they affirmed the WCJ's finding of unreasonable delay regarding Weight Watchers coupons, deferring the penalty amount for further determination. The Board also affirmed that the applicant's attorney is entitled to fees for enforcing the medical treatment award related to the coupons. The matter was returned for further proceedings on the penalty amount and attorney's fees.

Workers Compensation Appeals BoardReconsiderationJoint Findings and AwardPenaltiesSanctionsLabor Code Section 5813Labor Code Section 5814Labor Code Section 5814.5Unreasonable DelayMedical Treatment
References
1
Case No. ADJ3302147
Regular
Dec 09, 2013

LIDIA CHAVEZ-ESPARZA vs. AMY'S KITCHEN, ZURICH NORTH AMERICA

In this case, the defendant sought reconsideration of a Workers' Compensation Appeals Board (WCAB) order imposing a 25% penalty for unreasonably delaying permanent disability payments. The WCAB granted reconsideration, finding that the applicant received the full amount of permanent disability benefits awarded. The Board noted that advances made under a dismissed specific injury claim were not an unreasonable delay for the cumulative trauma injury claim, especially given a stipulation that the applicant received the full owed amount. Therefore, the penalty and associated attorney fee were rescinded.

Petition for ReconsiderationPermanent Disability BenefitsUnreasonable DelayPenaltyLabor Code Section 5814Labor Code Section 5814.5Cumulative Trauma InjurySpecific InjuryStipulated AwardBenefit Printout
References
0
Case No. SBA 0076630
Regular
Mar 03, 2008

Janice Brackenridge-DeGraff vs. ACTMEDIA, INC., INTERCARE INSURANCE

The Workers' Compensation Appeals Board granted reconsideration, overturning a prior decision that denied penalties for delayed payment. The Board found the employer unreasonably delayed payment of the compromise and release agreement by 10 days beyond the agreed-upon 30-day deadline. Consequently, the Board awarded a 5% penalty on the delayed amount and a separate 5% penalty for the unreasonable delay in paying the legally owed interest.

Labor Code section 5814ReconsiderationCompromise and ReleasePenaltyUnreasonable DelayPaymentInterestAttorney's FeesCIGAWCJ
References
1
Case No. MISSING
Regular Panel Decision

Bovis Lend Lease (LMB), Inc. v. Lower Manhattan Development Corp.

This case involves a contractual dispute between Bovis Lend Lease (LMB), Inc. (Plaintiff), a deconstruction contractor, and Lower Manhattan Development Corp. (LMDC) (Defendant), responsible for redeveloping lower Manhattan after 9/11. Bovis was contracted to deconstruct the Deutsche Bank Building but encountered unforeseen regulatory interference and delays, leading to significant cost overruns. Bovis's amended complaint sought damages for extra work, general conditions, profit, insurance costs, and constructive acceleration. The court ruled that Bovis's claims for extra work due to regulatory interference and damages for delay were barred by the contract's 'no damages for delay' clause and the explicit assumption of regulatory delay risks by Bovis. While some claims were dismissed, others related to amounts due under the original lump sum contract, including overhead, profit, and insurance (excluding fire-related incremental costs), were reinstated after reargument. Ultimately, the court emphasized upholding the clear terms of the contract between sophisticated business entities.

Contractual disputeDeconstruction projectRegulatory interferenceDelay damagesNo damages for delay clauseExtra workConstruction lawAppellate reviewContract interpretationRisk allocation
References
8
Case No. ADJ6910970
Regular
Oct 18, 2010

LOUIS SOTO vs. LOWE'S HOME IMPROVEMENT

This case involves an applicant claiming injury to his right wrist, leg, and shoulder. The defendant sought reconsideration of an award finding unreasonable delay in authorizing a recommended angiogram and paying medical travel expenses. The Appeals Board granted reconsideration, modifying the award to assess the 25% penalty for the delayed angiogram against its actual payment amount, rather than its estimated value. Otherwise, the original award, including penalties for delayed medical travel expenses and the necessity of the angiogram, was affirmed.

Workers' Compensation Appeals BoardReconsiderationMedical Travel ExpensesLabor Code Section 4600Angiogram StudyMedical Provider Network (MPN)Permanent Disability AdvancesPenaltiesLabor Code Section 5814Unreasonable Delay
References
0
Case No. ADJ7022118
Regular
Feb 04, 2014

JOSE HUEZO vs. PACIFIC PJ, LLC, FIREMAN'S FUND INSURANCE COMPANY

In this workers' compensation case, the Appeals Board granted reconsideration to correct a clerical error regarding a penalty for delayed attorney's fees. The Board affirmed the finding of unreasonable delay in paying the attorney's fees, consistent with the Administrative Law Judge's initial decision. However, the penalty amount was amended to reflect a $10\%$ penalty on the attorney's fees plus additional fees awarded under Labor Code section 5814.5. The decision also included interest on the delayed attorney fee payment.

Workers Compensation Appeals BoardOrder Approving Compromise and Releaseattorney's feesLabor Code section 5814penaltyinterestunreasonable delayclerical errorSupplemental Findings and AwardWCJ
References
1
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